Healthcare Provider Details

I. General information

NPI: 1366595175
Provider Name (Legal Business Name): PAUL A RUGER R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 LAKE AVE
WOODSTOCK IL
60098-7401
US

IV. Provider business mailing address

719 GOLDENROD CT
CRYSTAL LAKE IL
60014-6982
US

V. Phone/Fax

Practice location:
  • Phone: 815-337-4116
  • Fax:
Mailing address:
  • Phone: 815-459-1099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: